Spinal Infection

What is a Spinal Infection?

A spinal infection is described as an infection of the spine. It can occur in various locations of the spine i.e., intervertebral disc space, vertebral column, spinal canal and nearby soft tissues.

Types of Spinal Infection

The different types of spinal infections are classified based on the region of the spinal cord infected, namely:

  • Vertebral osteomyelitis is recognised as one of the most common forms of vertebral column infection. It can develop from an infection in the surrounding region or one that spreads from another region of the body, or from direct open trauma to the spine.
  • Intervertebral disc space infections affect the space between adjacent vertebrae and can occur during childhood, in adults or after an operation.
  • Spinal epidural abscess is a form of spinal canal infection that develops in the space around the tissue lining the spinal cord and nerve root canal.
  • Subdural abscess is a rare form of spinal infection that develops in the potential space between the membranes that surround the spinal cord.
  • Intramedullary abscess is an infection that develops within the spinal cord.
  • Adjacent soft tissue infections are spinal infections of the surrounding tissues.

Causes of Spinal Infections

The causes of spinal infections include a bacterial or fungal source, Staphylococcus aureus, and Escherichia coli being the most common. It may occur as a post-surgery complication. Some of the factors that can increase your risk of developing an infection may include

  • Intravenous drug abuse
  • Neonatal complication as in childhood discitis
  • HIV infection
  • Long-term use of steroids
  • Malnutrition
  • Certain conditions such as diabetes mellitus and cancer

Symptoms of Spinal Infections

Symptoms generally differ depending on the type of infection but can generally be defined by pain localized to the site of infection. You may also experience pain in the back, abdomen or flank.  Other symptoms may include:

  • Wound drainage
  • Redness
  • Swelling or tenderness near the infection
  • Fever
  • Chills
  • Muscle spasms
  • Weight loss
  • Weaker functioning of the nervous system
  • Pain or difficulty in urination
  • Bowel/bladder dysfunction
  • Paralysis, etc.

Diagnosis of Spinal Infections

Early diagnosis of spinal infection is often considered as the biggest challenge. Diagnosing a spinal infection may take anywhere from 1 month to 6 months, which impedes the timely and effective treatment of the infection.

Your medical history will be reviewed by your doctor and a thorough physical examination will be performed. Further imaging tests may be ordered including X-ray, CAT scans or MRI scans, and lab tests such as blood cultures.

Treatments for Spinal Infections

Treatment can include surgical and non-surgical methods.

Non-surgical treatment may be considered if the infection is mild with minimal or no neurological deficits and when surgery is usually contraindicated for a patient. Non-surgical treatment includes long-term intravenous antifungal or antibiotic therapy. The patients normally undergo antimicrobial therapy for a period of 6 to 8 weeks.

Surgical treatment may be recommended for spinal infections when there is:

  • Notable bone involvement
  • No response to antibiotic treatment
  • Neurological deficits
  • Failure of needle biopsy

Prognosis of Treatment for Spinal Infection

Spinal infections can be treated with antimicrobials and surgery. You will be monitored throughout your treatment for signs of improvement. However, there is a risk of residual infection or recurrence of the infection.

University of Leeds British Orthopaedic Association Royal College of Surgeons Swansea University NHS Royal College of Surgeons of Edinburgh